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- W2989569698 abstract "We present the case of a 29-year-old gravida 0 with a history of ureteral obstruction and hydroureteronephrosis due to deeply infiltrating endometriosis requiring left ureterolysis, complete left parametrectomy, and left salpingo-oophorectomy. She now presents with recurrent pelvic pain and a new right adnexal mass consistent with an endometrioma requiring surgical intervention. Secondary to her previous surgery, complete absence of the left parametria and broad ligament was noted intraoperatively. The entire length of the pelvic ureter was now intraperitoneal, as shown in Fig. 1. The uterine vessels had been controlled at their origin (clips visible in Fig. 2) to facilitate excision of the parametria in order to remove the fibrotic endometriotic tissue obstructing the ureter. After her extensive dissection and excision of endometriosis, the peritoneal surface had healed along the pelvic sidewall independently of the ureter. The entire length of the ureter could be followed intraperitoneally to the point where it inserted into the bladder at the vesicoureteral junction.Fig. 2Vascular clips can be seen in the lower left corner from previous ligation of the uterine artery at its origin off the hypogastric artery.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Ureterolysis is an advanced surgical procedure that is employed when dealing with invasive and complex pathology, such as obstructive ureteral endometriosis. Risks of performing ureterolysis include ureteral devascularization, denervation, transection, and thermal damage [1Darwish B Stochino-Loi E Pasquier G et al.Surgical outcomes of urinary tract deep infiltrating endometriosis.J Minim Invasive Gynecol. 2017; 24: 998-1006Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar]. Owing to the unique intraperitoneal location of the patient's ureter, there was a risk for injury and internal hernia, as it was no longer in its expected anatomic location. In this case, the ureter was initially thought to be a band of scar tissue until peristalsis was noted by the operating team. One case report describes accidental transection of a ureter during hysterectomy in a patient who had underwent pediatric ureteral reimplantation as a child [2Ritch JM Heidemann NL Ureteral transection due to intraperitoneal course of ureter after pediatric ureteral reimplantation.Obstet Gynecol. 2014; 123: 462-465Crossref PubMed Scopus (1) Google Scholar]. These cases highlight the importance of having a thorough understanding of a patient's surgical history to avoid inadvertent injury when an abnormal anatomy is encountered." @default.
- W2989569698 created "2019-12-05" @default.
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- W2989569698 date "2020-09-01" @default.
- W2989569698 modified "2023-09-26" @default.
- W2989569698 title "Identification of an Intraperitoneal Ureter after Ureterolysis" @default.
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- W2989569698 doi "https://doi.org/10.1016/j.jmig.2019.11.015" @default.
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